# Long-Term Treatment of Opioid Use Disorder

> **NIH NIH R01** · JOHNS HOPKINS UNIVERSITY · 2024 · $615,882

## Abstract

Poverty and opioid addiction are interrelated and chronic problems which have not been addressed
adequately. The Therapeutic Workplace could treat the many adults with opioid use disorder who are
unemployed and live in poverty. The Therapeutic Workplace pays participants to work. To promote drug
abstinence, the Therapeutic Workplace arranges employment-based abstinence reinforcement in which
participants are required to provide drug-free urine samples to maintain maximum wages. Many studies have
shown that employment-based abstinence reinforcement in the Therapeutic Workplace can promote and
maintain drug abstinence. Recently, we showed that abstinence-contingent wage supplements in the
Therapeutic Workplace could promote drug abstinence and employment, and reduce poverty. However, we
have not demonstrated the real-world impacts of the Therapeutic Workplace. The Therapeutic Workplace
requires two modifications to produce real world impacts. 1) We must develop a real-world version of the
Therapeutic Workplace that community treatment programs can implement. 2) We must reduce the costs of
maintaining employment-based abstinence reinforcement. This application seeks to develop and evaluate a
low-cost Therapeutic Workplace that community treatment programs can implement and that addresses the
persistent nature of opioid addiction and poverty. We propose to conduct a Stage III study in which a
community clinic (REACH Health Services) adapts and implements the Therapeutic Workplace intervention. To
improve the feasibility of this intervention, we will use low-cost abstinence-contingent wage supplements to
maintain abstinence. We propose to conduct a randomized controlled study to evaluate the effectiveness of the
low-cost abstinence-contingent wage supplements in a community Therapeutic Workplace to maintain long-
term drug abstinence and employment, and to reduce poverty in adults with opioid use disorder. After a 4-week
induction period, REACH unemployed methadone or buprenorphine patients with opioid use disorder (N=225)
will be randomly assigned to a “Usual Care Control,” an “Initiation Only,” or an “Initiation and Maintenance”
group. All groups will continue to receive methadone or buprenorphine treatment and will receive an
employment specialist for 72 weeks. “Initiation Only” and “Initiation and Maintenance” participants will earn
high magnitude abstinence-contingent wage supplements ($8/hour) during a 24-week Initiation period (weeks
1-24). “Initiation and Maintenance” participants will also earn low-magnitude abstinence-contingent wage
supplements ($1/hour) during a 48-week Maintenance period (weeks 25-72). We will base the primary
outcome measures on assessments conducted every four weeks of the Maintenance period. If low-cost
abstinence-contingent wage supplements in the community Therapeutic Workplace maintain drug abstinence
and employment and decrease poverty, community drug abuse treatment clinics could apply this intervention
widely as ...

## Key facts

- **NIH application ID:** 10772027
- **Project number:** 5R01DA053218-03
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** Kenneth Silverman
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $615,882
- **Award type:** 5
- **Project period:** 2022-04-01 → 2024-02-15

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10772027

## Citation

> US National Institutes of Health, RePORTER application 10772027, Long-Term Treatment of Opioid Use Disorder (5R01DA053218-03). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10772027. Licensed CC0.

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